Premium
Biochemical and imaging alterations of renal bone disease in newly detected predialysis and on maintenance dialysis patients
Author(s) -
Hossain R.M.,
Hoque M.E.,
Rahman H.,
Rashid H.U.,
Iqbal M.
Publication year - 2005
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1492-7535.2005.1121bn.x
Subject(s) - medicine , dialysis , hemodialysis , creatinine , osteopenia , urology , alkaline phosphatase , resorption , kidney disease , gastroenterology , endocrinology , osteoporosis , bone mineral , chemistry , biochemistry , enzyme
Objective: Bone involvement in chronic renal failure is manifested long before the initiation of dialysis and is more prevalent in patients receiving inadequate conservative phase management. This study aimed at identifying the extent of renal bone disease among pre‐dialysis and maintenance dialysis patients. Method: Thirty‐two patients (gr 1) on maintenance hemodialysis (HD) for variable period of time were compared to twenty newly detected, irregularly treated, (gr 2) pre‐dialysis severe renal failure patients for their clinical, biochemical, and imaging features. Result: Mean age of gr 1 and gr 2 patients was 45 ± 14 vs. 34 ± 15 years (p < 0.05). Comparison of blood biochemistry between group 1 and 2 showed serum creatinine 9.9 ± 2.9 vs. 13.4 ± 4.4 mg/dl (P < 0.01), calcium 10 ± 1.4 vs. 7.4 ± 1 mg/dl (p < 0.001); phosphate 4.4 ± 1 vs. 8 ± 2 mg/dl (p < 0.008); ionized calcium 4.7 ± 0.1 vs. 3.9 ± 0.7 mg/dl (p < 0.05); alkaline phosphatase 116 ± 31 vs. 86 ± 31 IU/l (p < 0.05); and iPTH 72 ± 48 vs. 147 ± 92 pg/ml (p < 0.05). Radiological changes present in the two groups were osteopenia‐63% vs. 65%(P = NS); trabecular resorption‐53% vs. 20%(p < 0.05); soft tissue calcification‐31% vs. 10%(p < 0.05); bone cyst‐16% vs. 25%(P = NS) and subperiosteal bone resorption‐16% vs. 20%(P = NS). Tc 99MDP bone scan combined in both groups of patients (n = 52) showed increased uptake in wrist joint (29%), tibia‐fibula (25%), costochondral junction, vertebral column (15% each), sternum (13%), radius and ulna (10%), and calvaria and mandible (8% each). X‐ray finding was positive for bone involvement in 59% cases and Tc 99 scan was positive in 80%(p < 0.05). Association study showed iPTH had a negative correlation with serum calcium (r = −0.5, p < 0.05) and a positive correlation with serum phosphate (r = 0.7, p < 0.05) and alkaline phosphatase (r = 0.9, p < 0.001). Conclusion: It is concluded that pre‐dialysis newly detected renal failure patients may present with deranged calcium homeostasis and can manifest high prevalence of bone involvement when compared to maintenance hemo‐dialysis patients.